Author Topic: Questions, Part 48 (part a)  (Read 2219 times)

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Questions, Part 48 (part a)
« on: August 30, 2009, 02:28:54 PM »
Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Mon Aug 25, 2003 5:15 am    Post subject: Educational Questions, Part 48.   

To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
><
> What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
><
>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
><
>I hope that we can help in furthering your dialysis education.
>Thank you!<
>Founding RN <
><
>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP!<
>

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Elaine



Joined: 26 Aug 2003
Posts: 1

   
PostPosted: Tue Aug 26, 2003 10:04 am    Post subject: quarterly labs    Reply with quote
I would like to understadn my labs better. I got quarterly labs:<
><
>hct - 32<
>hgb - 10.8 <
>ferritin - 1061<
>iron sat - 47<
>iron - 81<
>tibc - 170<
>uibc - 90<
><
>I currently get 2200 units epo per tx. My doctor looked at my labs and started to leave. With an hgb of 10.8 I asked him if I required more epo as I had read recently that my hgb should be at leaste 12 or I might be fatigued? So he upped it to 4000 something. But if I had not of said anything he was not going to make any changes.<
><
>Can you tell me what the above numbers mean and if they indicate any adjustments should of been made? It concerns me if values are out of range and if my doctor is really watching them. I want to be able to know my labs well so I can catch any mistakes and not have my doctor overlook them.<
><
>I was wondering if you could possibly take maybe one lab value a week and educate us on this board on what each one means and what adjustments are necessary?<
><
>Thank you for this board. It helps me greatly!

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Wed Aug 27, 2003 5:48 pm    Post subject: Elaine    Reply with quote
Elaine,<
> The following site is a good place to start your education of lab values. It gives basic values for normal and renal failure. So first take a look at those.<
> Also look at the education topics as many of the labs are already posted. <
><
>www.azstarnet.com/~bsmith...bvalus.htm <
><
>As for the lab values that you posted, Yes, your hct is on the low side. Your Dr. increased the amount of EPO you get to 4000 units. Ask if this is 4000 units each dialysis run or 4000 units per week.<
><
>hgb is hemoglobin. another way to measure your hct. <
><
>The other values are from your Iron studies. Your Ferritin is high. If you are getting IV iron, it needs to be stopped. The other values measure the amount of iron in your blood. They are adequate as EPO needs iron to work at it's best.<
><
>Will try to go over the topics and see what I can do. I work full time and this is done in my spare time. <
><
>

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debbie



Joined: 27 Jan 2003
Posts: 11

   
PostPosted: Sat Sep 06, 2003 8:09 pm    Post subject: alkaline phospate   

Hello,<
>I recently posted here about bone/joint pain..... I have had an appt with my dr who is reinvestigating my parathyroid (Have had it removed). He also repeated all my routine bloods which are all ok except my alkaline phospate. This has been steadily rising for about 12 months but hasn't been noticed. After I convinced him that I don't touch alchohol he said he would speak with his colleagues and decide what to do.<
>I have done some searches on the net and have been able to link high alk.phos. with hyperparathyroidism and bone disease....... can you shed any light on this please?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Sun Sep 07, 2003 10:04 am    Post subject: Debbie    Reply with quote
I hope this answers your question. Calcium, Phosphorus, Vit D, Dialysis, Binders, diet, etc., all have an affect on each other and you. All are interconnected and really can not be separated from one another.<
><
><
>Renal Osteodystrophy: <
><
>Renal Osteodystrophy is the name given to all bone diseases found in the ESRD patient.<
><
>Cause:<
><
>As renal function deteriorates, the ESRD patient loses the ability to excrete phosphate. Phosphates/ phosphorus must bind with calcium in order to be excreted from the body. As the phosphate ions increase in the body fluids, the serum calcium in those same body fluids, decrease. <
><
>The Parathyroid Glands (PTH) are responsible in maintaining the balance between the calcium and phosphate/ phosphorus levels in the body. To do this the PTH gland then responds by increasing the production of the parathyroid hormone. (PTH)<
><
> This in turn causes calcium to be reabsorbed from the bone, which then results in the loss of bone density and strength. <
><
>The kidneys also manufacture the form of vitamin D that is needed for normal bone metabolism. When the kidneys fail, there is a deficiency. <
><
>Treatment:<
><
>Dialysis does not fully correct this malfunction. There is a higher calcium level in the dialysate bath then in the body serum of the patient so each patient does get added calcium while on dialysis.<
><
>Drugs such as Zemplar, Calcitrol, and Hectorol, which are Vitamin D analogs, given IV on dialysis, also help control this vicious cycle.<
>Taking your binders on a regular schedule also help keep this under control.<
><
>Goal:<
>The goal is to keep enough calcium in your body fluids to facilitate the removal of excess phosphates/ phosphorus so that calcium is not lost from your bones.<
><
><
><
>Alkaline Phosphatase (ALP)<
><
>Alkaline Phosphatase is an enzyme found in all tissues. When tissue is damaged or diseased, they release enzymes into the blood and serum ALP enzymes are elevated. Different types of isoenzymes are in different tissues and each has their own unique structure.<
>The ALP enzymes (isoenzymes) from liver and bone have different structures and can be separated and identified in the lab to indicate where the damaged or diseased tissues affected in the body are located. <
><
><
>Laboratory Values:<
><
>Normal: 30-115 U/ML.<
>Dialysis Normal: Same.<
> **Note Normal lab values may vary from lab to lab and with age and gender.<
><
><
>Abnormal High levels may indicate:<
>Bone disease<
>Anemia<
>Liver disease (Hepatitis) <
>Biliary obstruction <
>Healing fractures of the bone<
>Hyperparathyroidism<
>Leukemia<
>Osteoblastic bone cancers<
>Rickets<
>Paget's disease<
><
> Normal periods of elevation are found periodically in the following:<
>Growth spurts in children<
>Pregnancy in women<
><
>Abnormal low levels may indicate:<
>Malnutrition<
>Protein deficiency<
><
>Some drugs that may affect the lab test for ALP:<
>Antibiotics<
>Narcotics<
>Chlorpromazine<
>Tricyclic antidepressants<
>Methyldopa<
>Allpurinol<
>Cortisone<
>Propranolol <
><
><
>Symptoms:<
>Painful joints<
>Weakened bones (Osteoporosis resulting from hyperparathyroidism) <
> -may result in severe pain<
> -may result in deterioration of the bones.<
> -may require surgical intervention to slow down the process.<
> (partial or total parathyroidectomy)<
><
>Treatment:<
><
> The objective is to maintain a low serum phosphorus in the blood. The following help:<
 />><
>Oral phosphate binders<
>Regular dialysis<
>Low dietary intake of phosphorus<
>Vit D analogs such as Zemplar, Calcitrol, or Hectorol <
>Surgery: partial or total parathyroidectomy <
><
>

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Jill



Joined: 26 Feb 2003
Posts: 3

   
PostPosted: Mon Sep 08, 2003 11:46 pm    Post subject: PO4   

My doctor likes to see labs not exceeding 5.5, but others have told me their doctor says they should go by 4.5. Which is correct?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Wed Sep 10, 2003 7:12 pm    Post subject: Jill   

Phosphorus (P04)<
><
>The Normal level for dialysis patients is in the range of 3.5-5.5. Please you read the topic "Renal Osteodystrophy"? This explains what happens if the phosphorus and calcium levels are not kept in balance as much as possible. <
><
>For non dialysis patients: the level is 2.5-4.5 . <
>

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RedheadedReptile



Joined: 09 Mar 2003
Posts: 69

   
PostPosted: Sat Oct 04, 2003 10:09 am    Post subject: No Antibodies after rejecting a kidney?    Reply with quote
I rejected a transplanted kidney in 1992. A year later, an antibodies screening was run on my blood, which was negative. I thought rejecting a kidney meant you had antibodies... can your body eventually rid itself of antibodies, or do you keep them forever? <
>

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Sat Oct 04, 2003 10:13 am    Post subject: Redheaded Reptile   

Yes, most people have antibodies from their transplant, but as time goes by, these antibodies tend to go away. You are one of those lucky people who got rid of them faster than most patients do. <
><
>If you were to try for another transplant, and made sure that the tissue and blood type matched up to almost perfect, then you just might have a really good chance of it working.

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patient



Joined: 29 Oct 2002
Posts: 137

   
PostPosted: Thu Oct 16, 2003 5:07 am    Post subject: Tx Problem   

Got very sick on my tx. My regular machine which runs a cond of 14 had to go for re-pairs, so I was given a machine that had a cond. of 13.5. I know from past experience that I am affected if the cond. on the machine is too low. Everytime they have switched out the machine for one of low cond. I am affected. But this was the worst tx I've ever experienced. <
><
>I started feeling off not long into the tx. Then I got every symptom, somewhat dizzy, tight in the chest, warm, sweating, ears popping, hearing strained, voice strained. My bp did not drop as it normally would if I was close to my dw. I rode this out and by the end of the tx I begain to feel crampy in my hand so I had the UF turned off with just .1 to go. <
><
>Then I had a symptom I've never had--my body went completely freezing cold from head to toe. I'd like to know why did my body go cold like this and what caused the tx problem as my bp never dropped? I feel it was the low cond which dropped out of range to 13.4 at several points. Also what could I have done to correct the problem. I dont think anything could of been done if the cond was the problem.<
><
>I did recover after the tx feeling ok by the next day. I was given my regular machine back for the next tx after I
ought the problem to the admin. and had no problems.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Thu Oct 16, 2003 11:26 am    Post subject: Patient    Reply with quote
It sounds like Sodium modeling was not used on this new machine. If it was, then the base sodium should have been checked to make sure that it was set at 140. Sometimes when a machine is repaired, the base settings are not reset to policy and this is something that needs to be done. If this is what happened, then the symptoms you described feeling during the run would be something I would expect you to feel. You would still be removing fluid, but not in a way that would be comfortable to you. <
><
> Another thing to consider is, was the kidney rinsed out throughly, at least 1000 cc's? Do you do reuse? This might also account for some of the symptoms you describe.<
><
>As to feeling cold all of a sudden, you don't say if this happened after your blood was rinsed back or before. I would expect this to happen after the blood is rinsed back. You are getting your blood back and it is a bit cooler than your body temp along with that cold saline. Could you have gotten more saline back that usual? <
><
> I think that it was just the whole combination of the above that contributed to your poor treatment. <
><
> I would suggest that you make out a check list and after you are put on, go over it with the person who puts you on and the 2 of you can check to make sure that all is dialed in right. Esp, sodium modeling and fluid modeling if it is used.

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patient



Joined: 29 Oct 2002
Posts: 137

   
PostPosted: Thu Oct 16, 2003 3:39 pm    Post subject: Tx problem   

All settings were checked. I have a very good tech now who works with me in checking the settings together. The sodium was set for 140. <
><
>I have read in a dialysis manual that some patients get crampy symptoms when the conductivity is too low. I will go for months on my regular machine that runs a higher cond and not have a single problem. But when the machine is taken for maintainence, if a machine is given to me that has a low cond. that is when I have a bad tx. <
><
>I am on single use and my dialyzer is rinsed with 2 bags of saline each tx.<
><
>My body went from feeling hot and sweaty at about the 2nd hour of tx, causing me to remove my blanket, to feeling freezing cold in the last minutes of tx before my blood was returned. At this point I felt so bad and my hand was starting to cramp that I had the tech turn the UF off. I had my temp taken and it was 97. And I asked the nurse if a blood culture should be taken, but she said it is only taken if there is a problem in the first 2 hours of the tx.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: Fri Oct 17, 2003 4:27 am    Post subject: Patient    Reply with quote
Sodium Modeling always increases the conductivity of the machine and I think a lot of patients don't realize this. Just be sure that it is turned off the last 30 min of your run so that you don't get extra sodium. <
><
>Blood cultures are not drawn unless there is an actual increase of temp along with prolonged chills. That may be an indication of spticemia.This usually happens within the first 30 min. of the treatment. <
><
>Having not been there to see your treatment, it is hard to try to figure out exactly what went wrong. It still sounds like a combination of factors as I stated before.
"Like me, you could.....be unfortunate enough to stumble upon a silent war. The trouble is that once you see it, you can't unsee it. And once you've seen it, keeping quiet, saying nothing,becomes as political an act as speaking out. Either way, you're accountable."

Arundhati Roy